Please complete if you’d like to serve as a business development mentor for the Local Economy Incubator. The information you provide is confidential and will only be shared with your consent when you are matched with a Local Economy Incubator mentor or go before the Peer Review Panel when applying for a community-supported micro-loan.

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* 1. Name:

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* 2. Email:

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* 3. Phone:

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* 4. What is your gender?

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* 5. Languages Spoken (please indicate level of proficiency):

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* 6. How did you hear about the ASECO Community Revolving Loan Fund and / or the Local Economy Incubator?

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* 7. How long have you been a Time Banker?

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* 8. How has Time Banking affected your life?

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* 9. Have you had at least 3 transactions in the last 6 months with 3 different people?

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* 10. Current Business Name:

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* 11. Website:

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* 12. Type of Business(es) Conducted Currently or in the Past:

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* 13. Years of Experience in this Field:

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* 14. Expertise you can offer (select all that apply):

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* 15. Have you ever applied for a small business loan?

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* 16. How does your business give back to the community and/or positively impact the Arroyo SECO Network of Time Banks community?

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* 17. Does your business support, participate in or promote the Sharing Economy?

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* 18. Does your business have a social mission?

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* 19. Does your business promote environmental and/or community sustainability?

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* 20. Have you tapped the social capital of the ASNTB community in your business thus far?

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* 21. Have you ever mentored someone before?

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* 22. Why do you want to become a mentor for this program?

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* 23. What qualities do you think make a good business development mentor?

TIME COMMITMENT:

This project requires commitment and follow through to fully support our entrepreneurs. You will be compensated for your time in Time Credits by the Incubator. Though participation time varies depending on the needs of the participant and the mentor, we estimate that mentoring could take at minimum meeting just once for an hour to as much as 3 hours per week for multiple weeks.

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* 24. Can you devote at least 3 hours per week for 6 weeks?

ASNTB REFERENCES:

As a member of this community, we value your involvement, contributions and interactions with other members. We require that you supply at least 1 or as many as 3 MEMBER REFERENCES who can attest to your commitment to our community, integrity and follow-through.

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* 25. Please provide member FULL NAME, a brief description of your RELATIONSHIP/INTERACTIONS, how long you've known each other and why you've chosen to include this member as a reference:

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* 26. Is there anything not covered on this application that you would like the Local Economy Incubator to know about you?

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